From Grafts to Flaps: Applicability of an Interactive Surgical Mobile-based Simulator in Clinical Practice.

Sir,

The provision of education has changed substantially over the past decade, with the constant evolution of technologies creating platforms that enable surgical education to be delivered in vastly different methods. Simulation exercises are recognized as being effective in the transference of skills from training to the operating theatre.[1].

The era of “apps” is well and truly upon us, and mobile-based simulations are time effective, easy to access, and in some cases, superior to that of traditional didactic learning tools.[1-3] Touch Surgery is a mobile application which offers users a step-by-step interactive guide to a large range of surgical procedures across various specialties. The content is developed and produced by board-certified surgical specialists and includes procedures ranging from harvesting skin grafts through to harvesting free flaps (Fig. 1). Procedure details are condensed into practical steps with interactive steps such as “swipes” to simulation incisions, and each module/task has a “learn” and “test” module to allow for revision of key aspects.

Fig. 1.

Anterolateral thigh flap harvest. CT, computed tomography.

Our objectives were to assess the utility of Touch Surgery as a learning tool for surgical procedures in plastic and reconstructive surgery. A Likert scale questionnaire was distributed among members of plastic surgery units in 4 tertiary hospitals in Western Australia and the St. Andrew’s Centre for Plastic Surgery and Burns, United Kingdom. Interns, residents, service registrars, training registrars, and fellows were encouraged to participate. The survey was based on suitable simulations that were deemed appropriate for the level of surgical expertise. The intern/resident cohort carried out the “Split Thickness Skin Graft for Diabetic Foot” simulation, service registrars the “Open Carpal Tunnel Release,” and training registrars/fellow the “Anterolateral Thigh Flap.”

Data were collected from 12 participants: 5 interns/residents, 6 service registrars, and 1 training registrar. Nearly all participants “agreed” or “strongly agreed” that the “learning exercise was informative and straightforward” and that it “helped in preparing (them) for the operation” (Fig. 2). The intern/resident and service registrar cohorts found the application to be a useful learning tool; however, limited responses were obtained from senior trainees, and thus it is difficult to comment on its usefulness for more complex procedures. Eleven out of 12 participants would recommend the application to their colleagues.

Fig. 2.

Learning exercise.

A previous study assessing the efficacy of the Touch Surgery application in medical students found that those learning via the application scored higher than those learning via lecture slides (89.3% versus 75.6%).[2] Our results have provided further evidence in regard to the applicability of the program among junior doctors and surgical trainees in clinical practice. It is noted that, although our study is limited in sample size, it encompasses opinions from across various training hospitals in 2 countries.

Mobile-based interactive simulations through applications, such as Touch Surgery, may serve a useful role as an adjunct to formal surgical training. Our results indicate that it is an easy-to-use learning tool that may aid in the preparation of surgical trainees for operations, and perhaps in a method that the current and upcoming generations of trainees are more familiar with.